Evaluation of Radiographers’ Practices with Paediatric Digital Radiography Based on PACS’ Data

Objective: The purpose of the study is to evaluate radiographer practice with advanced digital radiography in terms of the values of exposure indices and deviation indices between hospitals in Saudi Arabia. Materials and Methods: The study is based on PACS’ data of paediatric radiographic images limited to the chest and abdomen performed during the last year from four hospitals in Saudi Arabia. P-value was calculated to investigate any significant differences exist between the values of exposure indices and deviation indices of the images, which will be acquired from the DICOM file of image data.Results: Most of the paediatric radiographic images (54%) were underexposed, as these images had deviation index with less than -1 from four hospitals compared to expected results. However, in one hospital, 58% of the images were overexposed. The majority of the underexposed paediatric radiographic images were chest and abdomen radiographic exam (50% and 66% separately). Results also show that most of the underexposed radiographic images were using a grid (66%); on the other hand, in the overexposed radiographic images, 59% did not use the grid.Conclusions: The findings of the study show the need for radiographers for further knowledge and training courses to improve their performance in digital radiography and paediatric imaging.

Paediatric Diagnostic Reference levels in low Resource Settings: A Guide for Developing Country Practitioners with excerpts from ICRP

Background: The practical implementation of Diagnostic Reference Level in paediatric imaging is a complex task due to their unique individuality in terms of high sensitivity to radiation, varying body sizes and presenting pathology. Hence, good knowledge of medical technology, skill to perform patient dosimetry and to analyze mage quality is required. Purpose: To provide a guide on the methodological requirements for the establishment of Paediatric Diagnostic Reference Levels (PiDRLs) based on the revised and updated guidelines from the current ICRP publication 135 on Diagnostic Reference Levels (DRLs). Materials and method: An extensive review of the ICRP report Publication 135 on Diagnostic Reference levels in medical imaging with a focus on paediatric imaging and other related studies were undertaken. Results: The ICRP report 135 updates and refines the recommendations of 2001. It highlights that the application of DRLs in paediatrics alone is not sufficient for the optimization of protection. Image quality must be evaluated. Quantities used for DRLs should be appropriate to the imaging modality being evaluated, assess the amount of ionizing radiation applied to perform a medical imaging task, and be measured directly. For interventional procedures, the complexity of the procedure may be considered in setting DRLs. DRLs shall not be used for individual patients or as trigger (alert or alarm) levels for individual patients. Appropriate weight bands (generally with 5 or 10 kg intervals) are recommended for establishing paediatric DRLs and should be promoted. Conclusion: The amount of radiation used for examinations of children can vary tremendously due to great variation in patient size and weight from neonates to adult-sized adolescents. This variation in patient radiation dose is appropriate. However, variation in patient doses due to inappropriate technique or failure to child-size the imaging protocol is not appropriate. This forms the basis of the new ICRP guideline and should form the basis of developing PiDRLs.

Diagnostic accuracy of perinatal post-mortem ultrasound (PMUS): a systematic review

ObjectiveUltrasound is ubiquitous in live paediatric imaging; however, its usage in post-mortem setting is less established. This systematic review aims to evaluate the diagnostic accuracy of paediatric post-mortem ultrasound (PMUS).DesignMEDLINE, Embase and Cochrane Library databases were queried for studies published between 1998 and 2018 assessing PMUS diagnostic accuracy rates in children<18 years old, using autopsy as reference standard. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies 2. A bivariate random-effects model was used to obtain combined mean estimates of sensitivity and specificity for different body systems.ResultsFour studies were included, all relating to ultrasound for perinatal deaths. The mean diagnostic sensitivity and specificity for neurological abnormalities were 84.3% (95% CI: 70.8% to 92.2%) and 96.7% (95% CI: 86.5% to 99.3%); for cardiothoracic abnormalities 52.1% (95% CI: 27.6% to 75.5%,) and 96.6% (95% CI: 86.8% to 99.2%); and for abdominal abnormalities 78.4% (95% CI: 61.0% to 89.4%) and 97.3% (95% CI: 88.9% to 99.4%). Combining all body systems, the mean sensitivity and specificity were 73.3% (95% CI: 59.9% to 83.5%) and 96.6% (95% CI: 92.6% to 98.4%).ConclusionsPMUS demonstrates a reasonable diagnostic accuracy, particularly for abdominal and neurological abnormalities, although cardiac anomalies were less readily identified.Trial registration numberCRD42018106968.

Measurements of CTDI and DLP from CT image data for paediatrics radiological performance evaluation and dose optimisation in Ghana

Risk of developing cancer in paediatric patients is higher compared with adults and hence need for optimization strategies in paediatric medical imaging is very critical. The higher risk is attributable to the fact that children have developing organs and tissues which are more sensitive to the effects of radiation, and also they have longer life expectancy which allows more time for any harmful effects of radiation to manifest. Optimization of radiological protection is a means of adjusting imaging parameters and instituting protective measures such that required images are obtained with lowest possible radiation dose, and net benefit is maximized to maintain sufficient image quality for diagnostic purposes. Special consideration is given to the availability of dose reduction measures for paediatric imaging equipment. A unique aspect of paediatric imaging is with regards to the wide range in patient sizes and weights, therefore requiring special attention to optimization and modification of equipment, technique, and imaging parameters. Good radiographic technique for paediatrics include attention to patient positioning, field size and adequate collimation, use of protective shielding, optimization of exposure factors etc. In CT, dose reduction is optimized by the adjustment of scan parameters such as mA, kVp, and pitch in accordance with patient weight, age, region scanned, and study indication. Paediatric radiological imaging should therefore be performed by trained and experienced health personnel in the medical imaging department. The overall aim of the research was to enhance the capability of Ghana to improve the efficiency of existing modalities for paediatric medical imaging and to implement and enhance optimization techniques and methodologies for advanced paediatric medical imaging in CT. In addition to providing appropriate clinical recommendation for clinicians for dose management during CT scan. MVL DICOM application software was used to access image data during abdominal CT scan. Effective dose estimates were estimated as developed by ICRP 103 recommendations. The data collection was based on retrospective extraction of image data, using MVL platform where detailed information of the CTDIvol and DLP were available for recording. The weighted CTDI (CTDIW) was estimated by multiplying the volumetric CTDI (CTDIVOL) by the pitch factor. The effective dose was estimated by the product of the region-specific normalizing constant and the dose length product on each image. For image quality Signal to Noise Ratio was estimated and compare with effective dose for dose optimisation. In conclusion, the mean dose parameters exceeded the recommended dose parameter and hence an urgent need for an action to minimise radiation dose to paediatric patients.